title: Clinical outcome and predictors of survival in late relapse of germ cell tumor.
abstract: OBJECTIVE
  Late relapse (LR) of germ cell tumor (GCT) is a well recognized entity associated with poor survival. We report on our experience with LR and determine predictors of survival.
  
  
  METHODS
  From 1990 to 2004, 75 patients were managed for LR of GCT at our institution. Clinical and pathologic parameters were reviewed. Estimates of cancer-specific survival were generated using the Kaplan-Meier method, and a Cox proportional hazards model was used to assess potential predictors of outcome.
  
  
  RESULTS
  The median time to LR was 6.9 years (range, 2.1 to 37.7 years). Overall, 56 patients (75%) had LR in the retroperitoneum, including 25 (93%) of 27 patients initially managed without retroperitoneal lymph node dissection. The 5-year cancer-specific survival (CSS) was 60% (95% CI, 46% to 71%). Patients who underwent complete surgical resection at time of LR (n = 45) had a 5-year CSS of 79% versus 36% for patients without complete resection (n = 30; P < .0001). The 5-year CSS for chemotherapy-naive patients was significantly greater than patients with a prior history of chemotherapy as part of their initial management (5-year CSS, 93% v 49%, respectively). In multivariable analysis of pretreatment parameters available at the time of LR, the presence of symptoms (hazard ratio [HR] = 4.9) and multifocal disease (HR = 3.0) were associated with an inferior CSS.
  
  
  CONCLUSIONS
  The data suggest that meticulous control of the retroperitoneum is critical to prevent LR in the retroperitoneum. In multivariable analysis, patients with a symptomatic presentation and those with multifocal disease have a significantly decreased survival. Survival is greatly improved if complete surgical excision of disease is attained.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, 353 E 68th St, New York, NY 10021, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Sharp
authors.forename: Brett S
authors.initials: BS
authors.lastname: Carver
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
authors.forename: G Varuni
authors.initials: GV
authors.lastname: Kondagunta
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Motzer
authors.forename: George J
authors.initials: GJ
authors.lastname: Bosl
authors.forename: Joel
authors.initials: J
authors.lastname: Sheinfeld
mesh_terms: D000328:Adult; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008495:Medical Oncology / Q000379:methods; D015999:Multivariate Analysis; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D013736:Testicular Neoplasms / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome